Treatment for Men’s Health Issues and Erectile Dysfunction in Bellevue
Bellevue office opens February 2019
I am excited to announce that starting in the new year, my clinic Bellevue, Washington will open.
A first in Bellevue:
A Board-Certified Urologist specializing in Men’s Health, sexual medicine and prosthetics
- Erectile dysfunction, Peyronie’s disease, low testosterone, sexual dysfunction, infertility and request for vasectomy
- Pre-existing patients will not have the option to transfer their care to Bellevue, due to the set-up of this space and equipment limitations.
- Additional testing or surgery will be performed downtown where necessary.
1200 112th Ave NE Suite B-250
Bellevue, WA 98004
Learn more about your visit.
Map it on Google!
I am a novice when it comes to blogging. One of the things I find interesting when I look at this website’s statistics is the search terms used by people that ultimately lead them to this page. This post is in response to one of the searches that included “penile implant regret”. I am not sure what regret the person who searched the internet for that topic had, but I will share the details of a case that I recently managed.
Last year, I saw a man and his wife for second opinion. He had undergone penile implant surgery for erectile dysfunction a couple of months prior. His point of regret was penis size. He reported that he had lost almost 3 inches of penile length and his girth was significantly reduced. The penile implant was functioning, but both he and his wife were unsatisfied with the outcome. Upon examination, it was clear to me that the penile implant that was placed simply wasn’t long enough. The cylinders stopped short of the head of the penis. The reasons for that are many and may include:
- Penile abnormalities like scar tissue or Peyronie’s Disease
- Unforeseen technical challenges at the time of surgery
- Under dilation of the penis
- Under measurement of the penis
- Surgeon experience (or inexperience) and/or preference
No matter what the cause this man felt short-changed.
Options for management:
- Do nothing – the implant was functioning well but the placement placed him at risk for thinning of the penile skin
- Remove the implant – he wanted to remain sexually active
- Remove the existing penile implant and replace it with a new one, making every effort to place a longer penile implant
Uncertain about his options, it took until this year for him to decide to replace the implant. Prior to his first surgery he used a vacuum penis pump and after his first consult with me began using it to stretch the penile tissues (even though he had an implant). Last month we removed the implant. I was able to place a penile implant that was 5cm (about 2.5 inches) longer than what he already had in place. My verdict was that he was short changed by a ‘one size suits all’ approach to penile implantation.
What are my thoughts on penile implant size?
- The best time to get it right is the first time
- Removal and replacement should be considered only after a discussion about goals and expectations, addressing the benefits but also the shortcomings of revision surgery. This could be higher rate of infection, falling short of goals or not fixing the problem you set out to treat.
- Men need to understand that the biggest complaint after implant is that penis will seem shorter than it did before, even when we are doing what we can to optimize implant
- To optimize the penis length before implant men may use a vacuum erection device to stretch the penile tissues
- In my opinion, experience matters. The old teaching was to undersize implants. Prosthetic urologists are move adept and getting the sizing correct. We have a broader skill set that we use even in difficult cases when we encounter unexpected anatomy.
The overall satisfaction rate for penile implant surgery is >90%. Partners of men with implants report similar satisfaction rates. Seeking a second opinion at least helps men better understand their surgical options.
The other day I saw a new patient, who came to see me to discuss problems he was having with his penile implant. It was placed by another surgeon, a few years ago, before he relocated to Seattle. The problem was not with the mechanics of the penile implant. He was delighted with how adept he had become inflating and deflating the device. He was happy with the firmness of the erection and said everything was great except…
He did not like the position of the pump in the scrotum. He wondered if there was anything we could do to correct this. I examined him and found the pump to be sitting high up in the scrotum. It seemed to crowd the under surface of his penis. He described to me that it commonly got in the way during intercourse.
I explained to him the importance of pump positioning and the approach that I take in placing the pump. I try to place it at or slightly above the testicles. Doing this gets the pump ‘out of the way’. The goal is to have the pump placed just under the skin, where it is easy to palpate. If the pump is placed too low or too far back it may be difficult for men to function the penile implant.
Common pump position problems include:
- high-riding pump under the penis or up into the groin
- pump placed too deeply making it hard to hold
- tubing is too long and it coils up or causes pain for the partner
- pump is too low and is out of reach
- skin is too thin and I’m worried that it will erode through the skin
- The best time to get it right is the first time. Care and attention at the time of the initial surgery usually avoids pump position problems.
- Usually, I spend time troubleshooting the device to look for a solution that does not involve re-operation.
- If it is early in the recovery phase I instruct men to massage the pump gently several times per day and gently tug and pull the device. This can improve the final position after healing.
- Often times, the pump is in a good position, but the problem is ‘too much tissue’. Men who gain weight will sometimes have more difficulty finding their pump. It gets buried in the extra tissue and losing weight may solve the issue.
- Surgery is an option if all else fails
Surgery to Reposition a Penile Implant Pump
This is usually performed as an outpatient, and men will go home the same day. The recovery is much quicker and simpler than it is for the initial surgery to place the penile implant. Rarely, is it necessary to replace the pump or any of the other components of the implant.
In the pre-op area I mark the skin when the patient is standing. This indicates the ‘ideal’ final resting place for the pump. I use the previous incision to open the scrotum and this allows me to free up the pump. The tissues are irrigated with antibiotic solution to reduce infection risk. The pump is then relocated and secured into place. If the tubing is too long, I may trim it. If the tubing is too short, one option is to replace the existing pump with a new pump.
Once the swelling has resolved in 7-14 days, men can resume using the penile implant.
- Pump position matters and attention at the time of implantation can avoid problems.
- Issues with pump position are actually uncommon and many men do not require re-operation.
- Surgical reposition is a straight forward procedure and yields a high rate of satisfaction